Applicant

 

Surname___________________________. First Names_______________________

 

Address_____________________________________________________________

 

Contact Telephone _________________________Mobile______________________

 

Service No     ___________________________  Date of Birth__________________

Email.__________________________________

Has your Membership ever been declined, Suspended or Revoked from any Club?    YES/NO

I hereby agree to abide by the rules of the club and certify that the above information is correct.

I enclose          

Returned	$15.00
Service	$20.00
Associate	$30.00
Total  amount paid	$

 

You require two members of the Huntly RSA to nominate you.        ( Not required for Returned and Service)

 

We know the applicant personally and in accordance with the rules, recommend him/her for membership

 

Proposed by:_________________________________  _______________

                             Please Print     Name                                  Membership No

 

Seconded by_________________________________   ________________

                             Please Print Name                                      Membership No

 

Office use: Amount paid ___________________________    _________________   

                                                                                             Membership No